Referral Specialist

ABC Medical is one of the nation’s leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and services that includes: Urological, Incontinence, Wound Care, and Ostomy.  ABC Medical is part of the JDS, Inc family of businesses.  Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services. 

Work Location: 

Monday-Friday; Hours: 8:30am-5pm local time 

Responsibilities: 

The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meets all local coverage determinations and regulatory requirements.  The Referral Specialist is responsible for the Pre-authorization functionality. 

• Examine documents to verify required compliance, completeness, and accuracy of data. 

• Confer with document originator and approvers to resolve identified discrepancies. 

• Contact insurance companies to confirm insurance coverage and eligibility of products. 

• Obtain prior authorization and/or referrals. 

• Appropriately update customer database when obtaining documents and pre-authorizations. 

• Appropriately update document databases, and corresponding files. 

• Generate communication to the appropriate personnel on new and revised documents including Pre-authorization requests. 

• Regularly communicate with Health Care Providers, Commercial and Government Payors, and Sales Managers. 

• Achieve defined service level agreements. 

• Communicate Payor requirements as they are discovered. 

• Adheres to all HIPAA guidelines/regulations. 

Minimum Qualifications: 

• High School Diploma or equivalent work experience 

• 2+ years of work experience 

• Basic understanding of payor guidelines 

• Analytical skills required, attention to detail, and organized 

• Basic Microsoft skills. 

• Ability to work well in a team environment 

Preferred Qualifications: 

• Previous DME experience  

Here’s what we have to offer: 

• Variety of Medical, Dental and Vision Insurance Plans 

• 401k Plan with Company Match 

• PTO and Paid Holidays 

• EAP 

• Employee Discounts